Diabetes, Insulin Resistance, and the Metabolic Syndrome in Patients With Acute Myocardial Infarction Without Previously Known Diabetes

Abstract

OBJECTIVE—Individuals with diabetes have an increased morbidity from acute myocardial infarction (AMI). Based on an oral glucose tolerance test (OGTT), 40–45% of patients with AMI have diabetes. The objective of this study was to characterize the glucometabolic profile of patients with AMI without known diabetes and to see if sustained glucometabolic perturbations are predictable during the hospital phase of the disease. RESEARCH DESIGN AND METHODS—A total of 145 patients with AMI and no previous diagnosis of diabetes were subjected to an OGTT at hospital discharge and 3 months thereafter. Based on the OGTT after 3 months, they were defined as having normal glucose tolerance (NGT; n = 50), impaired glucose tolerance (IGT; n = 59), or diabetes (n = 36). Components of the metabolic syndrome, including insulin resistance assessed by homeostasis model assessment (HOMA-IR), were recorded. RESULTS—Patients with AMI had no changes in insulin resistance from hospital discharge to follow-up. An OGTT and/or a single blood glucose taken 60 min (BG-60) after ingestion of 75 g glucose at hospital discharge were predictors of the outcome of the OGTT at follow-up. With a cutoff value for BG-60 of 8.6 mmol/l, 70% of the patients were correctly predicted as either belonging to the NGT group or the IGT/diabetes group after 3 months. Age, BMI, antihypertensive treatment, HbA1c, fasting blood glucose, blood lipids, insulin, proinsulin, HOMA-IR, and plasminogen activator inhibitor 1 did not add predictive power. CONCLUSIONS—Patients with AMI and no previous diagnosis of diabetes have no changes in insulin resistance from hospital discharge to a 3-month follow-up. An OGTT or a single BG-60 performed at hospital discharge predicts the diagnosis of IGT or diabetes 3 months thereafter.

Depressive symptoms and insulin resistance in young adult males: results from the Northern Finland 1966 birth cohort

“…Insulin resistance, using the WHO cutoff point, was defined as the lowest quartile of the QUICKI of our study population. 11 In addition, the lowest quintile and decile of the QUICKI were also used to explore whether more strictly defined IR is associated more strongly with depressive symptoms.…”

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…Accordingly, the appropriate screening method is an OGTT, 2,21 which should not be performed earlier than 4-5 days after an ACS to minimize false positive results. 204,205 In-hospital and long-term mortality after MI has declined but outcome is still poor in DM, probably due to a higher prevalence of complications and a lack of evidence-based treatments. 206,207 Available information favours a proportionately similar efficacy of cardiovascular risk management in DM and non-DM patients but, due to their higher absolute risk, the number needed to treat (NNT) to avoid one cardiovascular event is lower in patients with DM.…”

Wytyczne ESC dotyczące cukrzycy, stanu przedcukrzycowego i chorób układu sercowo- -naczyniowego opracowane we współpracy z EASD

“…Podwyż-szone wyniki oznaczeń HbA 1c i FPG mogą być podstawą rozpoznania cukrzycy [299], jednak uzyskanie prawidłowych wartości nie wyklucza zaburzeń glikemii. W takim przypadku odpowiednią metodą badania jest OGTT (omówiony szczegółowo w części 3.3) [3,38], którego nie powinno się przeprowadzać wcześniej niż po 4-5 dniach od wystąpienia ACS (czyli ostrego MI lub niestabilnej dławicy piersiowej), aby ograniczyć możliwość uzyskania fałszywie dodatnich wyników [300,301].…”